GW1--00016_Well Construction - GW1_20231218

. •v=mu.‘.....mo 11tut.11UN RECORD(GW-1) FOr internvi USa flwl.+
L Wen A iaL•pr InEotme/ .�7.
Ricky Corriher •
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WellCo�eaaria�
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2464A /L � nwacaTrAamminemin
R ft.Wel Con eadarC xe®ber
Frank A.Corriher&So --�-� =.__=�--:---_--_
Sons WeII Drilling, Inc. �. _�_
121//t GI -- R ft. � MA11$7Ay
Zg`� n Permit lJ / r
laIIOa6detnetloaerittp WC Cow ;= -
Vatiaace,etc) }1 R 69 ft'3.We Lhe(check wen use): � SDR 21`
Water Supply Wen:
R ft. in. 111111 _
°Geothermal(Heating/CoolinsSupply) Water Supply(single) R ft. lin-
al Water Supply( ___-; —�—
Non-Wets Supply Wen: °Wells>100,000(PD ■•� ... NNE. i ieA�omt.
DMo g0°Recovery ft.
ft- ft- BenfiOnite Hole plug
Injection Well: ft.
_
rer Strange ertrdReeovery OSaliartyB�irs -��-rr. __ _:-.. — - _
°Aquif rTe t O R ft.
0
Te Dice Control ft. ft.
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Geotbeal(Closed Loop) OTacer, __—
C nsooFa$R�aa) pother(apla_ maim jai Renzado © 1'- "•. :t -a=•= s: -��" ?�
• n�eigrania )��_ ,v 2S.nate Well(s) : 2�".eL1 wen DM _ -2.d ft- C 2
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Pagel No.(PIN, a�.& 'x,..>r; �;
5b.Latitude mad longitude in de$tees/m®atr_slseoonds or decdegrees:al des: s 7 n
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CtftiellSell.onehrficagissoffieieat) a_
/6.in(are)the wa�(s) R1P or OTemporary of _..,.-.WeIICoai�oai Yr>' "��';,l �•
Date
Byagning this herebyc�adtr thenel10) f l rttadinacco►dance:nth
this as toase is4mgwelt I°Yes or LSdNr4CO2CC.100arISANC4CO2C.0200WdlCa utiony}anicralsaadthatamoy
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►epar:alderV!rom&seen*oratthe back afddsfone+- --- .
23.She diagram or additional wend
•
s.For
° aGeoprod9 sl'is needed mot Geothermal Wells having. the sameYon may use tl:e back of this page to provide additional wellca tlCipn�p
1 TOTAL Ni7I�ERofwetls (add'SeeOver.m
Malt
Rem Boa).You may also ad p i' R
// 24.SUBMITTAL INSTRUCTIONS
9.Total well deo&bebwLmds surface: (9
Fareeea plewdls&staSdgoelts f *ample-3(�Z00'atrd2(aJd00') (�) Submit this G -1 within 30 day of wen completion per the
18.Static water level below tap of Wig; 0_5 (IL) 24a. For AP Well= Original form to Dividrm of Water Resources IJxvarderdtsabote axe-+- • - Informal/on ProcessingUnit,1617 MSC,Raleigh.NC 27699-1617 � '
U.Bones s` I
d»re�: Cm-) 24h.For Injection Wells:Copy to DWR,Und l Control
12Wey m ad:Air Drill Prog ,1636MSC,Raleigh,NC27699-1636 ��
on.
24a For Water Dumb,and
Gtethesm a W el=Copy to the
Cm eager,many,cable.,(rang pasb,etc.)
county envnonmentd health d imeatofthecountywhereinstalled
FOR WATER SUPPLY WELLS ONLY: •
�
24d.For Water Wells over 100.000 GPD:
Y>rld(�) ® Method of test:Air Pamir ,1611 Raleigh,NC 27699-1611 Copy to DwR,CCpCiJA
13h.Disinfection typh Sterilene Amount a °le- •
FamGW-1 rl6ifgc`ato}maD of Eavao>rmmml •
Quail*- °£water Resources� • .
Revised 642018